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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203808550
Report Date: 11/05/2021
Date Signed: 11/05/2021 03:37:00 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MIS ANGELITOS MIGRANT HEAD START CENTERFACILITY NUMBER:
203808550
ADMINISTRATOR:LUGO, LOURDESFACILITY TYPE:
830
ADDRESS:75 E. ADELL STREETTELEPHONE:
(559) 675-5725
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:16CENSUS: 3DATE:
11/05/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Rosalva RomeroTIME COMPLETED:
04:00 PM
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On November 5, 2021, Licensing Program Analyst (LPA) Brannon conducted a case management visit. LPA met with Center Director, Rosalva Romero. During today's visit, LPA toured facility grounds and took a census.

A previous annual visit was conducted on November 3, 2021. During the visit, LPA observed facility was utilizing a changing table made out of rubber. LPA asked center director why was there not an one inch changing pad on the changing table. LPA was informed that licensee, Community Action Partnership of Madera, was informed by a CCLD representative that the one inch changing pad was not required when utilizing the rubber changing table. Upon returning to the office, LPA reviewed this with LPA Duarte and other management team members. It was determined that the licensee is to adhere to Title 22, section 101439 (h)(1): Infant changing tables shall have a padded surface no less than one-inch thick and be covered with washable vinyl or plastic. A Technical Violation has been issued during today's visit.

Exit interview conducted with Center Director, Rosalva Romero.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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